How do I begin

Advance Care Planning is a lifelong journey that begins with having an open conversation with your loved ones. Remember, there is no right or wrong way of care planning and you certainly don’t have to finish the conversation all at once.

ACP can be carried out informally by discussing your end-of-life wishes with trusted loved ones. You don't have to write down your wishes, although it can be helpful for your loved ones to refer to in the future. You may even want to share your wishes with your doctor. For patients with more complex conditions, ACP discussions may need to be facilitated by a trained healthcare professional. These Facilitators are currently available in most public hospitals.

4 Simple Steps to Carrying out Advance Care Planning

Think about it

Consider what you need to live meaningfully and what would be important to you at the end of life.

If you have a health condition, understand what your prognosis and treatment options are.

Talk with loved ones

Discuss your wishes and goals for care with your trusted loved ones to help them better understand your decisions.

Choose one or two loved ones who can be your voice. Involve them as you make your decisions.

Share and discuss your choices for future healthcare with your family doctor.

Review your preferences

You can always change your mind after your plans are made. If that happens, be sure to update your ACP documents and make new copies for the people you trust.

What decisions may my loved ones have to make?

Advances in medicine and technology have enabled people to live longer – even when a cure is no longer possible. In these situations decisions must be made about the use of emergency treatments to keep you in your current state. The doctors may use machines to do this. Decisions that your loved ones may need to make on your behalf may relate to CPR (cardiopulmonary resuscitation), use of a ventilator, tube feeding (or artificial nutrition and drips), and comfort care.

Cardiopulmonary Resuscitation (CPR)

CPR is a medical intervention that may be performed if a person stops breathing or when their heart stops. It can include:

Breathing into a person’s mouth and pressing onto his chest to enable his heart to start again.

Tube feeding

Tube feeding is a way to deliver nutrients through a tube if the person cannot take food or drink through his mouth. It may be temporary or permanent depending on his medical condition. The person may have a tube that leads from the:

Intubation

A person may require intubation if he is unable to breathe for himself. Intubation involves the insertion of a long breathing tube or artificial airway (endotracheal tube - ETT) into the trachea (wind pipe) via the mouth. On some occasions, the tube may be inserted through the nose down into the trachea.

What should I say to my loved ones?

Whether you’re making a plan yourself or helping a loved one with one, take the time to plan what you want to say and how you want to say it.

Setting the stage: ACP conversations can take place anywhere, but your loved ones might be more receptive when you approach them in a setting which they feel comfortable in. Can you think of a suitable place or time of day?

Start with a familiar topic: If you have difficulties talking about care at the end of life, sharing what you witnessed or learnt from past experiences, encounters and observations can help ease you into your ACP conversation. Common examples include:

- Death of a family member, friend or colleague
- Hospitalisation or serious illness in the past
- Newspaper articles and TV news stories
- Books and magazines
- Scenarios from movies and TV shows
- Religious teachings

Go slow and keep an open mind: Discussing healthcare matters can bring up concerns and uncomfortable feelings. You may even realise that your loved ones do not agree with your decisions. That’s okay. The important thing is that you’ve started the conversation. Be patient and give them time to let it all sink in.

Conversation Starters

“If you ever get really sick, I would be afraid of not knowing the kind of care you would like. Could we talk about it? I’d feel more at ease if we do it now."

"I’ve been thinking about the future. I realise we haven’t talked about our future health care decisions.“

"I was reading an article about the importance of letting your loved ones know how you'd want to be cared for right until the end. Can I tell you what I'd want?”

"Did you hear about that awful accident in the news? Life is so unpredictable. If something happened to you and the doctors needed me to decide for you, I really would be at a lost. Maybe we should talk about it while we can."

“This TV drama got me thinking. I don’t know what healthcare decisions you would want me to make if something happened to you suddenly. You might not know what I want either. This may not happen anytime soon, but I think we should talk about it.“